| |
15982 Quantico Rd Ste E Apple Valley CA 92307-1382 | |
(760) 946-2070 | |
(760) 946-1511 |
Full Name | |
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Speciality | Psychiatry & Neurology |
Location | 15982 Quantico Rd Ste E, Apple Valley, California |
Authorized Official Name and Position | Naomi Vivian Fate (PRESIDENT) |
Authorized Official Contact | 7609462070 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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15982 Quantico Rd Ste E Apple Valley CA 92307-1382 Ph: (760) 946-2070 | 15982 Quantico Rd Ste E Apple Valley CA 92307-1382 Ph: (760) 946-2070 |
NPI Number | 1891700241 |
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Provider Enumeration Date | 07/31/2006 |
Last Update Date | 10/15/2020 |
Certification Date | 10/15/2020 |
Medicare PECOS PAC ID | 2264600204 |
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Medicare Enrollment ID | O20110719000525 |
Identifier | Type | State | Issuer |
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1891700241 | NPI | - | NPPES |
Provider Name | Dale Anne Alexander |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1477714095 PECOS PAC ID: 5395882088 Enrollment ID: I20091029000211 |
Provider Name | Don W Kreger |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1609975515 PECOS PAC ID: 8123296944 Enrollment ID: I20110722000086 |
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